Locoregional Therapies for Primary and Metastatic Breast Cancer: <i>AJR</i> Expert Panel Narrative Review.

Overview

This article explores the growing role of minimally invasive locoregional therapies in the multidisciplinary treatment of primary and metastatic breast cancer. Factors contributing to the expanding role of ablation for primary breast cancer include earlier diagnosis when tumors are small and increased longevity of patients who are poor surgical candidates. Cryoablation has emerged as the leading ablative modality for primary breast cancer due to its wide availability, lack of need for sedation, and ability to monitor the ablation zone. In patients with oligometastatic breast cancer, emerging evidence suggests that use of locoregional therapies to eradicate all disease sites may confer a survival advantage. Evidence also suggests that transarterial therapies (including chemoembolization, chemoperfusion, and radioembolization) may be helpful in some patients with advanced liver metastases from breast cancer in the setting of hepatic oligoprogression or inability to tolerate systemic therapy. However, the optimal modalities for treatment of oligometastatic and advanced metastatic disease remain unknown. Finally, locoregional therapies may produce tumor antigens that, in combination with immunotherapy, drive anti-tumor immunity. Although key trials are ongoing, additional prospective studies are needed to establish the inclusion of interventional oncology in societal breast cancer guidelines, to support further clinical adoption and improved patient outcomes.